Provider Demographics
NPI:1881693968
Name:CRUSBERG, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:CRUSBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:NH
Mailing Address - Zip Code:03077-1220
Mailing Address - Country:US
Mailing Address - Phone:603-895-3351
Mailing Address - Fax:603-895-8003
Practice Address - Street 1:128 ROUTE 27
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:NH
Practice Address - Zip Code:03077-1220
Practice Address - Country:US
Practice Address - Phone:603-895-3351
Practice Address - Fax:603-895-0773
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30200048Medicaid
NH30200048Medicaid
NHRE5037Medicare PIN